{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICHARD CREIGHTON","gend":0,"add":"50 CAVALIER DR APT 140  ","city":"PETERSBURG  ","state":"VA","zip":"23805-9998","dob":"1959-03-15","age":"","mstatus":"","insh":11018388,"cliId":"4XG7KY4PW71","pno":8045861088,"cno":8045861088,"email":"","ename":"","eno":"","pphy":"ENDE, MARK  ","ppno":8047338771,"pcpadd":"121 S Market St","pcpcity":"Petersburg  ","pcpstate":"VA","pcpzip":238034217,"pcpcounty":"","pcpid":"P0060267","pcpname":"ENDE MEDICAL PRACTICE LLP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"","add3":"","madd1":"50 CAVALIER DR APT 140  ","madd2":"","madd3":"","mcity":"PETERSBURG  ","mstate":"VA","mzip":"23805-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","R79.9","I10","E78.5","E11.8","C62.11","N20.0","C62.91","R05","U07.1","R50.9","J06.9","Z79.84","E78.00","F17.210","L08.9","L03.90","U09.9","R73.01","Z86.16","Z00.01","M86.9"],"date":["2021-11-23","2021-07-21","2021-11-23","2021-11-23","2021-10-07","2021-09-09","2021-09-02","2021-09-02","2021-09-10","2021-09-13","2021-09-10","2021-09-11","2021-09-10","2021-09-10","2021-09-10","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-11-23","2021-11-23"],"priorHcc":[null,"",null,null,"","","","","","","","","","","","","","","","",null,null]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68180047803","SIMVASTATIN","10MG","30","Select","Select",""],["","00378456105","POT CHLORIDE","10MEQ ER","30","Select","Select",""],["","64980028005","GLIPIZIDE","5MG","180","Select","Select",""],["","65862020399","LOSARTAN","100MG","90","Select","Select",""],["","51224012250","AZITHROMYCIN","500MG","5","Select","Select",""],["","59310011720","PROAIR","","1","Select","Select",""],["","71715000221","NUZYRA","150MG","20","Select","Select",""],["","00597015337","JARDIANCE","25MG","30","Select","Select",""],["","71715000221","NUZYRA ","TAB 150MG","20","Select","Select",""],["","68180047803","SIMVASTATIN ","TAB 10MG","30","Select","Select",""],["","51224012250","AZITHROMYCIN ","TAB 500MG","5","Select","Select",""],["","00597015337","JARDIANCE ","TAB 25MG","30","Select","Select",""],["","59310011720","PROAIR ","AER ","1","Select","Select",""],["","64980028005","GLIPIZIDE ","TAB 5MG","180","Select","Select",""],["","65862020399","LOSARTAN ","TAB 100MG","90","Select","Select",""],["","00378456105","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}